Wednesday, December 18, 2013

2014 Budget Deal Includes SGR Patch, Therapy Cap Exceptions Extension

The $1.014 trillion federal budget compromise passed by Congress includes a 3-month "fix" that will prevent implementation of Medicare payment cuts associated with the sustainable growth rate (SGR). The temporary patch is intended to allow the House and Senate time to finalize legislation that would permanently repeal the flawed SGR formula.

The patch prevents a 20.1% cut to the conversion factor in the physician fee schedule and extends the current therapy cap exceptions process. In past years, the so-called "doc fix" was approved for an entire year—this time, legislators hope to use the first 3 months of 2014 to hammer out details of a plan that would not only end the SGR but could include a repeal of the therapy cap. APTA has created a webpage that explains the SGR reform proposals on the table.

Under the 3-month extension of the therapy cap exceptions process, physical therapists will continue using the KX modifier at the 2014 cap level of $1,920 and will be subject to the manual medical review process when a patient reaches $3,700 in annual spending.

The Senate is expected to return on January 6 and the House on January 7. Congress will resume negotiations on the proposals and begin discussing how to pay for the cost of the SGR reform legislation.

APTA will continue to work the members of Congress to ensure the final reform package includes policies that reflect the interests of physical therapists and the patients we serve. Members interested in joining APTA's advocacy efforts to reform SGR and repeal the therapy cap can sign up for PTeam.